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5/28/11

Everyone's talking about ...

Psychopaths. Jon Ronson was talking about them on The Daily Show last week, and thanks to how amusing he was (I bet), all 12 copies of his new book The Psychopath Test were sold out at my local Barnes and Noble. Ronson says 1 in 100 of us are psychopaths. Your neighbor might be a psychopath ... or your wife. Here's what I don't get--"psychopath" seems like a word like "imbecile" or "degenerate" or "lunatic". It's psychological and scientific, but also expressive--we use it to express rejection and disdain. Yet Ronson talks as if it could be a straightforward fact that some number of people are psychopaths. So I am puzzled. If there are any mental health professionals reading, I'd like to know: is "psychopath" really a current diagnostic label? Could it really be applied to such a vast number of people--1 in 100??!

Everyone does seem to be talking about it. The most recent episode of This American Life is all about this. Apparently there is a commonly used, though controversial, test used to determine psychopathy, the PCL-R.

There is a diagnostic category of antisocial personality disorder (APD). This is a very broad category, largely defined by behaviour. While most people meeting psychopathy criteria would meet APD criteria, only a minority of those meeting APD criteria could be classified as psychopathic.

Despite not making it into the diagnostic manuals, the construct of psychopathy is still widely used in forensic circles - largely for risk assessment purposes. Mainly because it is thought to be a very good predictor of recidivism (I've assisted on a few psychopathy assessments myself - many years ago now though).

Like all psychiatric concepts, it involves facts and values. It probably is true that there are a small number of people who are superficially charming, callous, manipulative, remorseless, impulsive, prone to violence and so on, but the decision to classify this cluster of personality traits and behaviour as 'disorder' is ultimately a moral one.